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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

CMS Proposed Changes to the HHQRP

July 27, 2015 09:26 AM

In the proposed rule for the calendar year (CY) 2016 Home Health Prospective Payment System Rate Update, the Centers for Medicare & Medicaid Services (CMS) proposes additional home health quality reporting requirements as part of the home health quality reporting program (HHQRP).

The HHQRP requires that home health agencies submit selected quality data in order to receive the full annual payment update (APU) for the payment year associated with the respective reporting year. Agencies that do not submit the quality data, as required by the HHQRP, are subject to a 2% market basket percentage reduction in payments.

The current HHQRP requires agencies to submit 70% of their Outcome and Assessment Information Set (OASIS) quality assessments and quarterly Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) data in order to receive the full APU. 

In the proposed rule, CMS proposes to increase the OASIS assessment submission threshold to 80% for the reporting year that begins July 1, 2016, through June 30, 2017, for payment year 2018, and 90 % for the reporting year July 1, 2017, through June 30, 2018, for payment year 2019 and forward.

In addition to the current quality data HHAs are require to report, CMS is proposing one new quality measure that will be required for the implementation of the Improving​ Medicare Post- Acute Care Transformation (IMPACT) Act.

The IMPACT Act was passed in September 2014 and requires the CMS to develop quality measures, resource use measures, and assessment data to be used across post-acute care (PAC) providers. PAC providers identified in the IMPACT Act include skilled nursing facilities, long term care hospitals, inpatient rehabilitation facilities and home health agencies. The Act also requires that CMS develop quality measures and standardized data elements under eight specific domains and within specified application dates for each PAC provider.

The eight domains are as follows:

  • Functional and cognitive status and changes in functional and cognitive status
  • Skin integrity and changes
  • Medication reconciliation
  • Incident of falls
  • Transition of care
  • Resource use measures, including total estimated Medicare spending per beneficiary;
  • Discharge to community; and
  • Measures to reflect all-condition risk- adjusted potentially preventable hospital readmission rates

CMS must select measures under the domains of skin integrity and medication reconciliation by 2017 for HHAs. For Calendar year 2016, CMS is proposing to require HHAs begin reporting a quality measure that addresses the domain of skin integrity and changes in skin integrity. The National Quality Forum (NQF)-endorsed measure: Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678) has been selected. The measure would be collected using the OASIS items M1308 (Current Number of Unhealed Pressure Ulcers at Each Stage or Unstageable) and M1309 (Worsening in Pressure Ulcer Status Since SOC/ROC). Since this measure is already collected by agencies from the OASIS assessment there should not be any addition administrative burden associated with collecting and reporting the proposed measure. The IMPACT Act requires that CMS implement its provisions with as little administrative burden to providers as possible.

CMS is considering a future update to the numerator of the new quality measure. This update would hold providers accountable for the development of unstageable pressure ulcers and suspected deep tissue injuries (sDTIs). At this time, CMS is not proposing the implementation of this change (that is, including sDTIs and unstageable pressure ulcers in the numerator) in the HH QRP, but is soliciting public feedback on this potential area of measure development. CMS is also seeking public feedback on whether height and weight as a measure of body mass index should be used as a covariate for risk-adjusting the measure in the home health setting, as is done in other post-acute care settings.

CMS proposes to include the new skin integrity measure in the HHQRP which would affect CY 2018 and subsequent year payment determinations. CMS does not specify how payments will be impacted but will most likely follow the current payment adjustment of 2% market basket reduction for non-compliance. The IMPACT Act also contains a   public reporting requirement of the cross setting measures that CMS must implement.

In addition to the one new measure, CMS proposes four future cross-setting measure constructs within the domains of: (1) All condition risk-adjusted potentially preventable hospital readmission rates; (2) resource use, including total estimated Medicare spending per beneficiary; (3) discharge to community; and (4) medication reconciliation. CMS is seeking public feedback to inform them on future measure developments as it relates to meeting the IMPACT Act requirements (see Table 22 in the proposed rule).

CMS must complete cross setting measure development and selection, and cross setting assessment data elements by 2019. Therefore, there has already been much activity within CMS to meet these requirements. Several Technical Expert Panels are been convened and we should begin to see increased notices of proposed rulemaking (NPRM) as the measures and assessment data are developed.

The National Association for Home Care & Hospice encourages providers to review the proposed rule and CMS’ plans for implementing the IMPACT Act. Input from the home health industry will be vital in ensuring that the IMPACT Act is implemented with due consideration towards home health agencies and with the least amount of burden.




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